Psoriasis

Psoriasis is a chronic inflammatory condition characterized by clearly defined, red and scaly plaques on the skin. Psoriasis is a global condition affecting people of all ages, with peaks of onset at 15-25 years and 50-60 years. It tends to persist lifelong, fluctuating in extent and severity.

Symptoms

Based on the characteristics of plaques and the body part affected, psoriasis is categorized into five major subtypes, namely:

Plaque psoriasis – Most common form of psoriasis, characterized by red raised plaques with silvery white scales that develop on elbows, knees, scalp and lower back.

Guttate psoriasis – Small pink spots distributed on the trunk and limbs. Usually presenting after a streptococcal infection and self-limited in nature.

Other symptoms such as pain in joints (psoriatic arthritis), nail deformities and discoloration, and genital involvement in males, can also be seen.

Diagnosis

The diagnosis of psoriasis involves the physical examination of the patient’s skin and occasional skin biopsy for detailed analysis of the condition.

If joint pain is a concern, then X-rays are also ordered to evaluate for psoriatic arthritis.

Treatment

Several options are available for treatment of psoriasis and the choice depends on the type of psoriasis, area affected, disease severity and other patient-specific factors. The treatment approaches include topical therapy, phototherapy, and systemic treatment.

Topical therapy includes various medicated creams and ointments, applied directly on the skin or scalp for both treatment of flares and maintenance.

Phototherapy is exposure of affected skin to ultraviolet radiations. Several varieties of phototherapy treatments are available such as psoralen + ultraviolet A (PUVA), ultraviolet B (UVB), & narrowband UVB (NB-UVB). In PUVA treatment, affected skin is exposed to light after giving the photosensitizing drug, psoralen. Psoralen makes skin more sensitive to radiations and thereby treatment will be more effective.

Systemic treatment consists of immunosuppressive medications and a newer class of agents called biological drugs. Biological agents are reserved for treatment-resistant severe psoriasis, mainly because of expense, and possible adverse effects, however have been proven to be very effective.

In addition, sun exposure and maintenance of optimal weight tend to improve psoriasis, while smoking, alcohol ingestion, and stress have been shown to exacerbate it.